Execution
- 1Position the patient supine with the head elevated about 20° to 30° to align the horizontal canals.
- 2Quickly rotate the head 90° to one side.
- 3Observe for vertigo and horizontal nystagmus, noting geotropic or apogeotropic direction.
- 4Return the head to neutral and then quickly rotates 90° to the other side.
- 5Compare the intensity and direction of nystagmus to determine the likely affected side and canalithiasis versus cupulolithiasis pattern.
Positive outcome
The test is positive when positional vertigo with horizontal nystagmus is provoked. Geotropic nystagmus usually suggests canalithiasis, and the more intense side is commonly the affected side. Apogeotropic nystagmus suggests cupulolithiasis or anterior-arm canalithiasis, and lateralization rules differ.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Pagnini et al. (1989) | NA | NA | NA | NA | NA |
| Lim et al. (2013) | modified supine roll diagnostic study | NA | NA | NA | NA |
CommentSupine roll is the standard positional test for horizontal canal BPPV, but diagnostic accuracy is often reported by canal localization accuracy rather than simple Sn/Sp. Correct interpretation depends on nystagmus direction, intensity, and fatigue. Central positional nystagmus can mimic horizontal canal BPPV when the pattern is atypical or treatment resistant.
Moderate Clinical Value